Will SOMEBODY get honest about Universal Healthcare?

[Thunderbeast]

I was troubled last night by the discussion. The economics of MFA or a public option failed to deal with two fundamental issues:

TAXES WILL PAY FOR THE PLAN. Whether MFA, a subsidized public option, or expanded Medicaid, we must be honest enough to say those words. Sanders is right...a Universal MFA plan would likely be cheaper than the current system, but the mechanics must not be left vague. Voters are smart enough to figure that out, but I saw NOBODY last night with the courage to lay it out clearly.

MEDICAL COSTS MUST BE REDUCED...NOT JUST INSURANCE. Insurance is the method to impose cost controls on a system that is out of control. If insurers don't fill that role, the new government plans will (and must). Our society CAN NOT afford all of the therapies that have been invented. Multi-million dollar treatments invented and priced by pharma need to be reigned in. "Hail Mary" procedures during the last months of life are cruel and they bankrupt survivors.

A look at one of our local hospitals shows clearly how finance drives investment. Cancer wards are shiny new trimmed in brass and mahogany. The mental health unit is in the basement of a 100 year-old building. Which unit do you suspect is funded by private insurance? Which one largely serves Medicaid patients?

High quality health care that achieves outcomes similar to the rest of the industrialized nations is possible. It can be achieved for far less than we spend now. We must, however, bend the cost curve.

Medical and nursing programs must expand so more providers enter the field. Their school costs need to be socialized so that new doctors don't need to cover hundreds of thousands of dollars of debt.

These will be major disruptions to our current medical model. They will not be without some pain and sacrifice to providers and currently-entitled consumers.

The conversation about these disruptions must be made transparently and honestly if you want me to get excited about your plan.

[Tiggeroshii]

1. I think as the field narrows there will ve more time for sanders and warren to clearly lay out m4a.

[BlueMississippi]

3. and then we will lose 43 states, the house and the senate

Mission accomplished!!

[moose65]

5. So what's your solution, then?

Do tell!

[Thunderbeast]

21. I am FOR Medicare for all.

My point is that by judicious avoiding the costs, taxes, and potential disruptions, our candidates are making it sound like anyone can get immediate treatment from any provider at little or no out of pocket cost.

While the RIGHT thing to do, there will be disruptions. The ACA is STILL under fire from Obama's "You can keep your Doctor" comment.

Andrew Yang made a compelling argument that none of the others have made. Taking the burden of private insurance off of employers will make them more competitive in global markets. That transition will require some benefit for salary tradeoffs to keep workers whole.

I am just asking for transparency in the argument.

[Mike 03]

32. That's very fair

I agree. There's this idea that some people expect free health care and I don't actually know anybody who believes that we wouldn't and shouldn't pay for health care. I'd prefer the Medicare option to buy in and I definitely don't want to lose this election over this issue. People should also think about the wait times and the reality that the most expensive state-of-the-art treatment may not be available to everybody. By making these choices we will face some difficult moral dilemmas. That can't be ignored.

[questionseverything]

59. we need to start by controling costs

[DemocratSinceBirth]

6. I'm for Medicare For All Who Want it but your dire prediction is over the top.

[BlueMississippi]

10. It is not.

Hillary Clinton as first lady tried to create universal health care in 1993. In 1994, we lost the house in a landslide and almost lost the senate.

In 2009 and early 2010, ACA was being discussed. In 2010, we lost the house, the senate and many governorships in solidly blue states like NJ. Remember Scott Brown? He was elected to Ted Kennedy's seat in Massachusetts in 2010.

MfA is political suicide and no Democrat should ever bring it up. Medicare as a public option for those who want it is fine but never ever f with people's health insurance that they love.

[TCJ70]

18. Ummm...I think you have your decades wrong...n/t

[BlueMississippi]

25. Thank you kindly. I made the corrections.

I will probably be labeled "gaffe prone" on this board haha

[TCJ70]

27. Only if you make a habit of it! n/t

[Bev54]

62. Spoken like someone who knows nothing about universal healthcare

It is up to the dems to properly explain how it works and why it will bring down costs. Every democrat should be bringing it up and explaining it, time to get peoples heads out of their asses and get proper healthcare. You really like being turned down for procedures and testing? You like co-pays and deductibles? You need to do some research.

[Kablooie]

2. I'd like to know just who is soaking up all the extreme profits.

Because they will be the people most likely to lose in a national plan so will be the most vocal (and well funded) opponents.

[BlueMississippi]

9. It is an urban myth that there are obscene profits in health care

There are things that are different in US Healthcare as compared to other countries

1. Constant innovation of new devices, new diagnostic modalities, new treatments and new drugs. Other countries don't even come up with 1% of the total healthcare innovations and the investment in those is absorbed by the current system.

2. Rationing of care by means of fewer facilities and waiting lists.

To give an example -- let's say there are 8 fast food restaurants in a town each charging about $8 per meal. We want to reduce the cost to $5 per meal. This can be accomplished by centralizing all fast food into next town over and charge only $5. Of course, people can't just walk in, pay and get their meal - they have to stand in line to get it. They also have to drive to a central location where the official fast food outlet is located.

In the US, we have an "on demand" system where we can get care where we want and when we want. If you checked with UK, Canada and AU, if one wants a hip or knee replacement, one has to wait months to get it and not at every hospital. Waiting list to get a CAT scan or MRI is also months long. In the US, you can usually get one in 2 days. Every elective procedure has a waiting list.


Americans are not ready to make that tradeoff.

[ChubbyStar]

13. Sure, here is a list of health care CEO's who have made out like thieves

Allergan CEO Brent Saunders, $6,624,473


Allergan CEO Brent Saunders. Reuters


Brent Saunders has been presiding over Allergan and its billion-dollar Botox empire since 2014, when a $66 billion merger launched the company as a member of Big Pharma.

Lately, though, Saunders' tenure has hit rocky times. Allergan still turns out a profitable business in cosmetics and eye care, but competition is also shaping up in those areas.

David Tepper's Appaloosa LP hedge fund has slammed Allergan's recent track record, calling for an independent board chair at the company — a move seen as an implicit critique of Saunders. Allergan's stock price was among Appaloosa's criticisms: It has steadily trended down since mid-2015, losing roughly 50% of its value.

Saunders' leadership also came under attack in 2017, when he spearheaded an ill-advised gambit to extend patent protection on a key Allergan eye product, and last year, when a strategic review didn't change much at the company.

Allergan's market cap: $48 billion






GlaxoSmithKline CEO Emma Walmsley $7,662,210


GlaxoSmithKline CEO Emma Walmsley. Reuters via handout


Emma Walmsley has led the British drug giant GlaxoSmithKline for about two years, overseeing a time of transition for the company.

Like many of its pharmaceutical rivals, Glaxo is on the hunt for profitable new products that can sustain it for years to come.

Walmsley, who last year was one of just 25 female CEOs in the Fortune 500, comes to the world of healthcare by way of Glaxo's consumer's health business. Before joining the drugmaker in 2010, the Oxford University-educated Walmsley worked at L'Oreal, the world's largest cosmetics company, for nearly 20 years.

But Glaxo is increasingly plotting its way out of consumer health, including its iconic products like Tums and Excedrin, seeing those as incompatible with innovative new products, including in cancer. Late last year, for example, the company announced a $5 billion bet on the cancer drugmaker Tesaro.

GSK's market cap: $203 billion









Illumina CEO Francis deSouza, $11,067,566


Illumina CEO Francis deSouza. Courtesy Businesswire


Francis deSouza became CEO of Illumina in 2016, succeeding Jay Flatley who had been in the post since 1999.

Illumina makes gene-sequencing technology used to turn samples of DNA into useful data for researchers and genetic testing companies alike.

Illumina's market cap: $47 billion






Walgreens CEO Stefano Pessina, $13,542,260


Walgreens CEO Stefano Pessina at the 2018 Forbes Healthcare Summit. Forbes/ Victoria Engblom


Following the merger of Boots Alliance and Walgreens in 2014, Stefano Pessina became CEO of the global pharmacy company.

Walgreens' stock took a hit in April after it missed its second quarter earnings and cut its forecast for 2019. The company has been inking partnerships with companies like Microsoft, Google's parent company Alphabet, Humana, and Kroger at a time when rivals like CVS Health have pursued big-ticket mergers.

Walgreens' market cap: $50 billion









Mylan CEO Heather Bresch, $13,346,299


Mylan CEO Heather Bresch attends a conference at the Cannes Lions International Festival of Creativity, in Cannes, France. Reuters


Heather Bresch has served as CEO of generic drug and EpiPen-maker Mylan since 2012. The daughter of West Virginia Democratic Senator Joe Manchin, Bresch weathered a storm of criticism around the emergency allergy device, when in 2016 its high price tag and frequent price increases were questioned.

Mylan's stock has been dropping in May after an earnings call did little to reassure investors about what the company would do to turn around its struggling business. The company is also one of the targets of a massive lawsuit accusing generic drugmakers of working together to set prices of key drugs.

Mylan's market cap: $10.5 billion

[BlueMississippi]

14. Those numbers are paltry as compared to

Defense contractors, Aerospace contractors, Auto executives and Tech companies.

Stop begrudging people just because they have money. Those people also make money for stockholders most of whom are average people's 401Ks and union pension funds.

[ChubbyStar]

15. That was a weak deflection

This thread isn't about defense contractors or any other contractors. Begrudging is your word not mine. Care to try again and address your point that profit in health care is a myth. Thanks!

[BlueMississippi]

24. CEO skills remain the same regardless of the industry

Are you saying we should get cut-rate executives for health care companies?

[ChubbyStar]

28. No

Can we get back to YOUR premise? You sure like to dance around the issue. Or roll on the floor, is that fun?

[BlueMississippi]

36. It is all about begrudging people who make money nt

[ehrnst]

45. Straw man....

YOUR point about the myth of no obscene profit in health care.

When one feels a need to misrepresent what someone else said to make one's point, it's time to examine the validity of one's point.

[Ninga]

31. Health care INSURANCE companies are the problem. Gross profits, Nt.

[BlueMississippi]

37. We live in a free market economy.

A lot of 401Ks and mutual funds are invested in many corporations that the ultra left just loves to hate.

If we took away the corporate profits, one may not get any returns on investments in 401Ks, IRAs or other vehicles.

[Ninga]

38. Wall Street would agree. Meanwhile, the working poor and destitute are collateral damage

kicked to the curb in favor of our 401k.

[ehrnst]

46. So is the goal to punish insurance companies, or is it to get universal health care?

Most developed countries utilize private entities - regulated of course - but even Canada utilizes private payors for Rx.

If there is a more feasible, affordable way to get to UHC other than single payer, would you accept that?

(I have asked the question of anti-choicers, "If there was a feasible affordable way to reduce abortions that doesn't involve closing down Planned Parenthood (as opposed to using money that subsidizes contraception for adoption services), would you support it?" The usual answer includes a denial that there is any way other than eliminating Planned Parenthood, because there is no moral solution that doesn't eliminate Planned Parenthood. I'm hoping for something different in reply to my question.)

[Garrett78]

49. Health care insurance companies don't profit as much as you might think.

Especially compared to other industries. However, the pharmaceutical industry does have obscene profits. Big Pharma is ripe for criticism.

That said, I don't think health care should be a for-profit industry at all. But pushing for the elimination of private insurance is not viable at this time. We can get there, but we first need a public option.

[Garrett78]

50. There's a difference between the health insurance industry and the pharmaceutical industry.

Big Pharma is horrific and the profits are obscene. No sane person can argue with that.

But that isn't the case with health insurance companies. Not compared to other industries. While I agree that ultimately we should do away with for-profit health care, the way to get there is with a public option. Doing away with private insurance in the near future is not tenable.

Also, CEO pay isn't the best barometer when it comes to profit margin. Obscene CEO pay with worker pay being stagnant and pitiful is a universal problem (i.e., it's been a problem in every industry for the last 40+ years). It's a systemic, cultural problem.

[Mike 03]

16. Please explain a couple things then regarding obscene profits.

You are right about waiting in Canada, and that is something we have to consider. My mother did have a hip replacement this year with a two month wait and a relative in Canada told us you could wait two or more years for that in Canada.

Why are things so overpriced here compared to other countries?

What is the explanation for Rattlesnake Antivenom costing $100 in Mexico but $14,000 in the US? Similar stories about Hepatitis B treatment, where you have Americans traveling to a country like India for treatment at a fraction of what it costs here? I've heard Insulin and anti-overdose treatments cited as examples.

What about these Hospital employees who get $300 a day just to check in on you for two minutes a day and make sure you're alive?

People look at their itemized bills and they don't understand why an aspirin costs $20. Are these not rational questions?

[ChubbyStar]

20. Great points thanks

I was told I "begrudge" people making money when I posted obscene salaries of health care CEO's.

[BlueMississippi]

23. Many reasons

1. Malpractice liability
2. Product liability
3. Higher overhead costs in the US
4. Extremely high regulatory costs in the US to get drugs, devices and facilities approved.

Many other countries eliminate these costs by a variety of methods. Many accept a US FDA's registration and dossier to rubber-stamp approval in their countries for example.

We are a very litigious society as well (as compared to other countries.)

[ehrnst]

80. One reason is malpractice insurance, another is the way that insurance

pools are set up.

(Just an FYI - if these charges are from an itemized bill that you got, I suggest that you contact Kaiser Health News. They are looking for people who have these baffling bills for monthly investigative news segments. https://khn.org/send-us-your-medical-bills/ )

America is a litigious society. Attempts have been made by conservatives to cap the $ amount that can be awarded. However, in malpractices suits, the vast majority of $ amount of the award is for ongoing medical care, especially if the person loses their health insurance because of inability to work, and until recently, they would not be able to get insurance for a pre-existing condition.

So, getting universal health care will bring malpractice insurance premiums down, because the physician's insurance will not have to pay out for ongoing care.

Hospitals and medical providers charge different people differently for the same procedure/device. Say an appendectomy actually costs $3000. An insurance company hospital may negotiate a lower rate of $2000 for a large group of members (the employees of a large company, for instance). So, to make up for that, the hospital will charge a smaller group $3800 for an appendectomy, and they will charge people with no insurance $4000. Or they charge someone $20 for an aspirin.

There are costs for the staff doing the negotiating, and keeping track of the various charges. Maryland has address this by mandating that hospitals charge everyone the same medical procedures - be it in a small group, large group or uninsured individual. After a few years, this brought costs down for hospitals and insurance companies because it eliminates the costs of negotiating different prices. Maryland also created mandates to reduce readmissions and provide more (lower cost) home care services when that is appropriate.

Maryland’s all-payer insurance model has helped keep costs down, the report said. Under the model, Medicare and private insurers pay the same rates for services at hospitals, although prices differ from hospital to hospital. Hospitals in the state also operate under global budgets that don’t allow them to generate more revenue than designated. They face a mandate to keep readmissions down and push more care out of the hospital.

https://www.baltimoresun.com/news/investigations/bs-md-sun-investigates-health-costs-20180215-story.html

If more states followed this model, then we would be on our way to overall savings. But as we know, the political will in each state to do this varies.

What about these Hospital employees who get $300 a day just to check in on you for two minutes a day and make sure you're alive?

Not sure which staff you are referring to, however anyone checking in on you must be highly trained to be evaluate the condition of patients, so it's far more than simply "checking in to see if you are alive." Ask any nurse about what their job entails. Now whether they bill patient visits per minute or per visit per day in is unclear. However, the point is, that these costs are not regulated, at least outside of Maryland.



I know that life flight services (Helicopter transport of the injured to a medical facility) are completely unregulated. They can charge what they want, and for that reason, often it's not covered by insurance, also because it's a fairly rare need.

As for the $14,000 snake anti-venom costs vs Mexico, there were several articles about that, but here is a graphic breaking down the elements of the cost in the US market:

Shockingly, the cost of actually making the antivenom — of R&D, animal care, plasma harvesting, bottling, and the like — added up to roughly one tenth of one percent of the total cost. Clinical trials to evaluate the efficacy of the antivenom accounted for another 2 percent. Other miscellaneous costs, including licensing fees, wholesaler fees, regulatory, legal and office costs, and profit to medical providers, added up to 28 percent.

In Mexico, Boyer says, authorities determined some time ago that treating venomous snake and spider bites was a public health issue. "Their policy has always been that the government will provide adequate amounts of antivenom via a massive purchase of the drug which it distributes to health clinics." We could try to implement something similar here, but it would require an act of Congress to do so.

https://www.washingtonpost.com/news/wonk/wp/2015/09/09/the-crazy-reason-it-costs-14000-to-treat-a-snakebite-with-14-medicine/

There was a recent bill was to make 250 drugs the same price for all as charged to Medicare. I don't believe that snake anti-venom was on that list, because snake bites are not considered a public health crisis in the US. Hopefully this will be the first step to a more expanded list, once the public gets used to those lower prices, and sees the negative consequences to pharma companies will be shown to be minimal, and will put pressure on their reps to expand.

The health care system is an ecosystem, and changes in costs that are introduced gradually have more of a chance of incorporation with minimal disruption to patient care. One can't simply make massive changes quickly to the entire system, because there has to be time to tweak and adjust when unknown consequences pop up.

Now Maryland has shown some success with their experiment in cost controls, other states might be willing to follow suit.

[CTyankee]

22. I have traveled extensively in Europe and asked people there if they would give up their health

care for an American style health care system. Not one person I talked to would switch! They like their system and won't give it up. What does that tell us?

[BlueMississippi]

26. It tells us that they are culturally different

Other countries trust their governments more.

Another thing it tells us is that people are comfortable with what they have and are resistant to change it. It is an issue dear to their hearts.

[CTyankee]

34. They know a lot about our health care. Most I talk to shudder at the thought of our type of

"health care." they think we are kinda crazy.

In fact, it's not just Europe. No other modern country in the world opts for our health care. So are they out of step with us or are we out of step with the rest of the world?

[emmaverybo]

55. Other countries are used to much higher taxes. However, these are rankling workers in France,

who are now pitted against immigrants whose benefits they claim they are paying for. The yellow-jackets are not pushing for more socialization! In fact, these high taxes have created such a wedge that Marine Le Pen, a far right Putin favorite, may become the next president.

In addition, those abroad are used to paying out of pocket for better quality healthcare and to paying for private insurance.

The NHS is increasingly privatized. Quality of care is uneven according to location, screening tests have long, long wait lists, elderly die before they get a hip replacement, emergency rooms shut down periodically and overflow with patients in hallways unattended, doctors and nurses flee the system. Now doctors’ councils decide the allocation of healthcare dollars. Sounds good, but isn’t as the doctors can indulge their self-interest over patients’.

Oh, and although it was mandated that cancer treatment be started within thirty days, that time has been extended, with many not getting treatment for three and more months.

It must be said that the system abroad does not see the numbers of GSWs we do here.

[ChubbyStar]

29. So have I

I think many people have not. Some of the replies in this thread indicate that. Shame.

[Thunderbeast]

30. With my employer-based private plan:

I had three changes of Primary Care Physician because of a change of carrier.

I waited 3 months to see a pulmonologist after two bouts of pneumonia.

My son had a seriuos mental health condition. There are exactly ZERO psychiatrists or psychiatric nurse practitioners in my city who take ANY insurance.

Sorry, your description of the best "on-demand" "see anyone you want" private health system is a complete fantasy!

[LudwigPastorius]

41. "It is an urban myth that there are obscene profits in health care"

Really?

https://www.cnbc.com/2017/08/05/top-health-insurers-profit-surge-29-percent-to-6-billion-dollars.html

[BlueMississippi]

43. Anyone's profit can surge 29%

If a hot dog stand sells 100 hot dogs one month and sells 129 hot dogs the next, its profit would "surge" by 29% too.

Just because someone's profit surged 29% it doesn't mean anything nefarious took place.

Or is it the 6 billion that bothers you and not the 29%? Like I stated in another post, it is always about begrudging "profit."

It sounds like the far left wants no one to make a profit. Everyone should run at cost or at a loss. Doesn't Bernie Sanders make a "profit" on his book deals or does he sell them at cost? When he sells his mansions, will he sell them at market price or sell them for what he paid for them? Or is it that some profits are ok but others are not?

[George II]

48. First, that's from 2017, more than two years ago. Second that is a 29% increase over the previous..

....year (2016) in that quarter only, obviously the increase in previous quarters wasn't near that otherwise the writer would have pointed that out. Third, the profit margin of the health care insurance industry is one of the lowest of any industry in the country - only 3-5%.

To put that "29%" into perspective, if the profit in 2016 was 3%, a "29%" increase represents less than 1% net increase overall (calculate 0.03 X 1.29). Even if the base profit was 5%, that "29%" represents an increase of only 1.6% to 6.6% overall.

A sensational headline by CNBC, but in fact a relatively insignificant increase.

More perspective - that $6 billion sounds like a big number (yes, it IS a big number), but that's profit based on $120 - $200 BILLION in operating expenses and payouts to doctor, hospitals, laboratories, etc.

[Beartracks]

52. Why is cost of US investment only absorbed by *our* system...

... when the benefits of that investment are global?

=======

[BlueMississippi]

56. Fair question

The problem is that it is a standard business model across many industries.

The investment is recouped from US sales and then, once the costs are fully amortized, the products are exported at a lower cost.

It is sort of like stuff that is incredibly expensive when sold in infomercials -- $19.95 for something that costs $2.50. Once the infomercial customers have paid that high price and demand is proven, the retail stores buy the same thing for $4.00 in wholesale and it appears on the shelves at $8.95

The price also goes down in the US but because of Medicare's complicated rules, the decreases are small. Many drug stores do buy them in bulk for less - some of the savings are passed on to consumers. However, since the most expensive drugs are not used over a long period of time, customers in the first epoch don't notice the reduced price paid by the people down the road.

The problem is that someone has to pay the development costs and regulatory burden costs. It is not unusual that a drug fails to get regulatory approval after spending $100 million in development. Big pharma usually work on 10 or more drugs, hoping one of them makes a big hit.

The solution would be either stop all new drug discovery or the government picks up the tab for R&D - like it does to defense contractors. Boeing or Lockheed don't pay the development costs for a new fighter jet and GM or Chrysler don't pay for developing a new tank -- Pentagon pays it all.

[Beartracks]

71. Thanks for the informative response. n/t

[KPN]

54. How do you define "obscene"?

Last edited Sat Sep 14, 2019, 06:41 PM - Edit history (2)

I’m guessing we are not on the same page in that regard. All I have to do is look at the CEO salary at the local rural hospital near me and it’s inflation (I say that euphemistically) over the past 30 years.

[BlueMississippi]

58. I didn't use the word "extreme" in my post nt

[KPN]

66. Thank you for the correction. I edited.

[BlueMississippi]

67. "obscene" is how some of the people perceive it

but then any profit made by whomever they are demonizing is "obscene."

The Health Insurance industry makes a profit of about 5-6% of sales.

Compare that to most other businesses that make 15-20% of sales.

Most of the hospitals in the US are non-for-profit -- so they don't make any "profit" at all.

Doctors and other health care providers make far less per hour (on average) than pipefitters, plumbers and many local government employees do.

So -- it is a myth to think that MFA will save much and will cause a massive chaos in health care delivery systems.

Yes, we do need to insure uninsured/uninsurable people -- but there is no need to cause a massive upheaval in the health care delivery system of 80% of Americans to achieve that goal.

[Bev54]

63. BS

You sound like a republican talking point. Rationing health care??? It is the US that is rationing healthcare for those who can afford it only. Elective surgeries do take a little longer and if you need an MRI you can get it quickly if you push your doctor or you can pay out of pocket for one immediately and they are not that expensive and it is still cheaper than what you pay for your monthly insurance premiums.

[BlueMississippi]

68. So you really don't have any "objective" rebuttal

just a "gut feeling?"

Please check the definition of rationing.

btw -- I am not advocating a republican position. I support giving uninsured people access to Medicare or another public option, subsidized to the extent necessary. I am simply not going to support uprooting the existing system and create something that will cause a massive chaos.

[JackFrost]

78. Right wing drivel...

Talking points right out of a corporate think tank. You do not speak for any "we" except the owners and corporate shills.

[CTyankee]

84. And yet, the US has poorer outcomes when you see a scoring of health outcomes of other

countries with some form of "socialized medicine."

I don't know the specifics about hip or knee replacements in terms of waiting times. Are these dire situations where the patient cannot wait for the replacement surgery? In that case, do the countries whose health systems you reference ignore that and still put patients on long waiting lists? Is a CAT scan or MRI crucial to the treatment of the patient in ALL cases in those countries?

Lastly, is there some reason I don't know of that other countries don't want our health care systems and prefer their own? I have traveled extensively in Europe and asked the people I meet there if they would prefer our system of health care and I hear an emphatic "NO" from them. Are they just stupid?

[PatrickforO]

88. OK, I beg to differ. Substantially.

The latest move by the big health insurance companies on hip replacements is to declare them 'elective surgery.' So, if you are like my colleague and don't have any cartilage between your femur and your hip socket so the bone just rubs together agonizingly, you get the hip replacement but not physical therapy, because hey, it was your choice to have this 'elective' surgery, wasn't it?

So, what's insulin now - maybe $750 a month? And we are in the world of $300 epipens. And what about Shkreli, who raised the price of a life-saving AIDS drug to over $7k per dose?

News flash, Blue, our 'on demand' healthcare system sucks. My ex pays $800/mo premium with a $5K deductible per year. nearly 45 million people in this country have no health insurance, and another 38 million have inadequate health insurance, which either doesn't cover certain conditions, has a really high deductible or both. And what about the 45,000 people a year who die because they don't have health insurance or have been denied treatment due to costs?

Our healthcare system is all profits over people, and the only reason we're even HAVING this debate is that big pharma and big health insurance lobbies have brought lots of dollars to the table, millions, and they will fight tooth and nail against even a public option.

But with a decade of Republican sabotage to the ACA, 2018 saw an increase in the number of uninsured people.

No, single payer is the only way to go, and this is a moral issue. Profit does not belong in healthcare, because the profit motive is in direct conflict with our interests as patients.

You really are spouting some classic right wing talking points. If you can afford the best healthcare, fine - more power to you. But you shouldn't get to go platinum when others have no healthcare and are desperately sick.

[wasupaloopa]

4. I Your op is very bias prejudice opinionated therefore not honest

That is what I find wrong with the healthcare debate. Everyone throws out things that are not proven

Taxes will not pay for the plan. That is a Bernie lie. We will pay for the plan!

Universal means universal not those you deem worth saving


I want to hear from unbiased think tanks. This idea of other countries do it so we can too is intellectually dishonest.

[Cuthbert Allgood]

7. So why can't we do it, then?

What unbiased think tank gives you facts that prove your point?

[wasupaloopa]

8. We haven't put it together yet

We haven’t put it together yet.

[Cuthbert Allgood]

12. So there's no reason we can't do it at this point?

[wasupaloopa]

17. Do something you haven't got the slightest idea how to go about and cannot

predict the outcome? I am amazed at people here who say they are more intelligent than trumpers yet want to go ahead with something that hasn’t been planned yet!

No business or government would do that. All you have are hopes and pie in the sky ideas.

We don’t even have the power to pass a bill!

[CTyankee]

35. I like to say that ours is a country that won world war II and put a man on the moon and we can't

get health care for all of our people?

[BlueMississippi]

11. See post No. 9

[Bev54]

65. What are you talking about?

Taxes will pay for the plan and yes that is you that pays taxes and why do you think the US can't manage to do what other countries have figured out? It is not intellectually dishonest, you are being dishonest by lack of knowledge of how it works. Do some research.

[gulliver]

33. Without a realistic path (and I'm not talking about a plan), the goals won't be reached.

The "how do we pay for it" argument against MFA isn't the strongest argument. The strongest argument against it is the "will people let us take away what they have" argument.

They won't. People don't let you take things away from them. If you try to take private insurance away from them, they'll vote against you. They won't care that you plan on providing them something better.

Then the "Medicare" part of MFA is not a great selling point. I have private insurance, and my mom is on Medicare. I think my insurance is better than hers. MFA proponents need to be clear that they are offering something more like a Medicare Advantage program than Medicare A+B+Medigap.

But if you say you are going to provide a public option that is equivalent to Medicare Advantage or MAPD (with drugs) and maybe dental and people can buy into it instead of private insurance, they'll go for it. Businesses will analyze it and buy it for their employees too. Over time, the public MAPD program will suck in all of the insurance business. Then government will pay for it. Then we have universal health care. All without "taking" something from anyone.

[5starlib]

39. No one talks about the loss of jobs in communities with private insurance

companies either.

[Blue_true]

47. When I was a boy.

A diagnosis of cancer was a death sentence, flat out, no chance, you planned your funeral. Today such a diagnosis comes with a survival probability. The price of that progress is expensive tests and hospital stays that can cover months.

If we are going to complain about modern healthcare costs, maybe we should admit that one sure way to reduce them is not to try to save people that become seriously ill or get seriously injured. Otherwise, we figure out how to pay for what we have and be creative with the solutions.

[Hoyt]

51. I agree. I would say one thing, just about any medical school grad can get loan forgiveness by

spending a few years in a medically underserved area, including some intercity locations.

Even if they are opposed to doing that, there is not other profession where if you make it through school, you are all but guaranteed to make upward of $200,000 annually. One can pay off a lot of debt and still live better than 80% of the population.

Oh, one other thing, I have been hearing about cost savings, etc., in health care for over 40 years, but it has never materialized. Don't count on it. Drug costs can be reduced some, but drug costs are less than 10% of our healthcare expenditures.

[George II]

53. You hit the nail on the head, the head that many seem to not understand - although they are....

....loosely connected, MEDICAL COSTS are entirely different from INSURANCE COSTS.

Even if we somehow come up with a plan that pays 100% of premiums, how do we know it will pay for 100% of the medical costs of those covered without a huge increase in taxes?

If the current insurance plan covers only 80% of medical costs and the individual is responsible for the other 20%, somehow we have to come up with that 20%. And then toss in eyeglasses and hearing aids and I think they're saying dental expenses, we're talking about a lot that isn't magically going to be "free", it has to be paid.

It's a case of pay me now or pay me later, but it has to be paid.

[LAS14]

57. Warren tells the truth, just not in sound bytes the GOP can use.

She won't say "taxes will go up." Instead she says, "the money in people's pockets will go up." Let those who want the details read the plan about how premiums, deductibles and co-pays balance out against increased taxes. Just don't give the GOP sound byte weapons. Paying an extra $5000 in taxes in return for not paying $10000 in health insurance is a good deal, but for some people "taxes" is a magic word. They'd rather keep paying the $10,000.

[elocs]

60. Lofty promises without an explanation of how they will really happen

play better than honesty.
Medicare for All is portrayed as a healthcare Nirvana, everything for everybody with no hitches at all. But when things seem too good to be true they usually are and most Americans will figure that out and vote accordingly.

[Bev54]

61. None of the candidates explain it properly

None of the candidates seem to truly have a grasp on how it works and that is disheartening. You would think that everyone of them would have done some research, it is not as if it is groundbreaking, many countries have it and all of us that do, would never want to see it go away. It is up to the candidate to explore all options of other countries and pick that which would work best for your country. It is not a hard concept but this bullshit that people don't want to lose their insurance company is the most ridiculous argument, I have ever heard. Everyone will get better coverage because they will not be turned down for their healthcare needs, no co-pay or deductibles. They can still get enhanced insurance through a company if they would like it. Yes you pay through taxes but it is far less money because everyone is paying and it is spread out amongst all people. I live in Canada and am fortunate to be healthy but it does not mean I am contrary to those who do need more healthcare. I do not notice the cost in my taxes, originally our sales taxes were to cover healthcare. We remain healthier because we can go to a doctor at anytime, no additional cost, which assists in prevention of illness and disease. You are the effing USA, supposedly the richest, most powerful nation, it is time to start acting like it and cover your healthcare, bring in gun laws, properly fund education and pay teachers, instead the prevailing attitude of less government; it is killing your citizens.

[Fiendish Thingy]

64. Sure, I'll be honest: I love it!

Moved from California to BC 7 years ago; we had a "Cadillac" plan under my union contract, and we did notice that for some things, mostly non-urgent specialist appointments, we had to wait longer than in the US.

Our first couple of months here, we had to pay the MSP premium out of pocket; the cost for both my wife and I : $124 CAD/mo., no deductibles, no copays. My employer then Picked up the premium and covered our extended benefits (dental , vision, chiro, prescriptions, etc). Just retired this summer, and I'm now paying around $150/mo for retiree extended benefits (which do have caps and copays) along with MSP, but the MSP premiums are going away in January- thanks Socialist NDP provincial govt!

I worked over 40 years providing mental health services to young people, both in the US and Canada. Many of the youth I worked with were poor, some undocumented. In California, every year, I had kids on my caseload who couldn't get healthcare for mild to major illnesses, or their family members couldn't get care, or couldn't afford care, for everything from the flu to diabetes and more.

That doesn't happen here in Canada.

I'm happy to wait a little longer for services knowing that everyone else gets care, regardless of who their employer is, or if they are unemployed.

IIRC, Canada transitioned to single payer health care a little over 50 years ago, and they didn't do it in a pragmatic, incremental manner. There was some fussing from doctors and insurance companies, but now it is the law of the land, and nobody from any of the 5 parties in Parliament (how refreshing!) is campaigning on abolishing it, only on how to improve it.

[dansolo]

75. I thought Canada did do it in a pragmatic incremental manner

I thought that different appraches started at the provincial level first, and only later became country-wide.

[Fiendish Thingy]

79. There may have been some provinces that had their own systems, but once Tommy Douglas' plan passed

it was nationwide- as I understand it, once the nationwide healthcare plan was passed, it was implemented, no incrementalism.

[Amimnoch]

69. I think we frame the argument poorly.

When we continue to push for any form of improved health care or form of universal healthcare we and our candidates constantly frame it from a humanitarian perspective. The problem with this approach is all evidence shows that the right and conservatives don’t have empathy for anything short of an unborn group of developing cells called a fetus.

When we talk about people losing everything due to the #1 cause of bankruptcy we envision human beings, they envision the fallacy of the “welfare queen”, or “ghetto minorities”, or “sponging illegal immigrants” all the while failing to realize that this is for THEIR benefit.. the benefit of THEIR families.. of THEIR friends. Never stoping to realize just how they themselves, no matter how well off they are are only 1 bad accident.. 1 kidney failure.. 1 heard disease... 1 cancer away from financial ruin themselves.

We need to start advertising, and attacking in a way that reaches such dense manners of thought:
1. Commercials and PSA’s showing the long working veterans, business owners, hard working middle and even upper class that have gone into financial ruin and bankruptcy due to a single turn of bad luck with a serious medical condition.
2. Illustrate how the uninsured/under insured seek high dollar emergency room care, and high dollar corrective care due to lack of availability or undesirable utilization of at lower cost preventative care that could have prevented their conditions getting to a higher cost corrective care condition.. PSA’s that explains why that 0.25 cent syringe costs $49 when utilized in an ER.. that they, and their insurers (which again is paid for BY them) are ALREADY paying for the care of others, but at a much higher dollar rate due to others waiting on conditions getting to a much higher (and unaffordable) corrective emergency condition instead of the lower preventative measures they could have opted for earlier.

Basically.. educating them in how this does actually benefit their own pocket books in addition to providing better access to care and eliminating their own risk of ruin in the event of a critical longer term condition affecting them directly.

[Politicub]

70. Insurance is the method to deny people coverage while lining the

pockets of insurance company executives.

Insurance is about making a profit. Yet you say it’s about cost controls? Oh, please. The way you wrote about insurance makes it sound like some charitable, benevolent force. It is not. It is a business designed to enrich a handful of rich people.

[Gothmog]

72. Speaker Pelosi-There's no need to reinvent health care -- just improve Obamacare

I agree with Speaker Pelosi https://www.cnbc.com/2019/09/17/nancy-pelosi-no-need-to-reinvent-health-care-improve-obamacare.html?__source=sharebar|twitter&par=sharebar

Democrats should focus on making improvements to Obamacare instead of trying to reinvent the wheel with “Medicare for All,” House Speaker Nancy Pelosi said Tuesday.

“God bless” 2020 Democratic presidential candidates putting forth Medicare for All proposals, Pelosi said in an interview with “Mad Money” host Jim Cramer. “But know what that entails.”

Pelosi’s thoughts on how to improve the nation’s health-care laws appear to align with those of former Vice President Joe Biden, who in his 2020 presidential bid is calling for building on provisions of Obamacare, formally known as the Affordable Care Act.

“I believe the path to ‘health care for all’ is a path following the lead of the Affordable Care Act,” Pelosi told Cramer. “Let’s use our energy to have health care for all Americans, and that involves over 150 million families that have it through the private sector.”

[Gothmog]

73. Societal Savings are not tax revenues and cannot be used to play for this plan

Such a plan in theory may generate societal savings but such savings would not pay for a program. Governments can only spend tax revenues and/or borrowings. This study does not say how one would pay for such a program in the real world. I note that Prof. Krugman like the concepts of such a plan in theory but notes that taxes will have to be raised a great deal to pay for such a plan
Back in 2016, here is his position Prof. Krugman compares Sanders hoped for health care savings to the GOP tax cuts. http://krugman.blogs.nytimes.com/2016/01/19/weakened-at-bernies/?_r=0

On health care: leave on one side the virtual impossibility of achieving single-payer. Beyond the politics, the Sanders “plan” isn’t just lacking in detail; as Ezra Klein notes, it both promises more comprehensive coverage than Medicare or for that matter single-payer systems in other countries, and assumes huge cost savings that are at best unlikely given that kind of generosity. This lets Sanders claim that he could make it work with much lower middle-class taxes than would probably be needed in practice.

To be harsh but accurate: the Sanders health plan looks a little bit like a standard Republican tax-cut plan, which relies on fantasies about huge supply-side effects to make the numbers supposedly add up. Only a little bit: after all, this is a plan seeking to provide health care, not lavish windfalls on the rich — and single-payer really does save money, whereas there’s no evidence that tax cuts deliver growth. Still, it’s not the kind of brave truth-telling the Sanders campaign pitch might have led you to expect.

Today, Prof. Krugman says that such a plan is feasible if you are willing to pay a great deal more in taxes
https://www.alternet.org/news-amp-politics/paul-krugman-explains-why-single-payer-health-care-entirely-achievable-us-and-how

If we went to government provision of all insurance, we’d pay more in taxes but less in premiums, and the overall burden of health spending would probably fall, because single-payer systems tend to be cheaper than market-based."

The amount of higher taxes are not quantified in this article by Krugman. To pay for any such plan will require massive tax hikes

Again sanders has utterly failed in his attempts to get Vermont to adopt his magical single payer plan because the state of Vermont cannot use hypothetical societal saving to pay for this plan. Even Krugman admits that much higher taxes are needed

[ehrnst]

81. +1000. Trillions of dollars being switched from one part of the economy to another in just 2 years

will not come without disruptions to not only health care delivery and insurance industry, but the ancillary businesses that feed into the health care and insurance systems. B

The U.S. health care system, said Jeff Goldsmith, a health care consultant and health futurist, is “the size of a country — it’s bigger than France — and it employs 16 million people. In moving to a single-payer system, he said, “you’re talking about reallocating $3 trillion, reducing people’s incomes and creating” in effect a single entity that would set prices for all medical services."

https://khn.org/news/democrats-unite-but-what-happened-to-medicare-for-all/

There is a reason that most countries that have UHC manage it at the state, regional or province level, and not at the federal level.

[elocs]

74. No, voters are not smart enough to figure out that MFA is cheaper, not as a whole.

Run on the "we will raise your taxes for MFA because we know what's best for you" and just see how that works out.
Run on "you can't keep the private insurance you like because that's not how MFA works and we know what's best for you" and see how that works out.

Medicare for All presents it self as the ultimate answer to all the healthcare problems, a virtual healthcare heaven on earth and it just comes across as too perfect and good to be true with no downside to it at all. In this case, people are generally smart enough to realize that when something sounds too good to be true it usually is too good to be true.

MFA is popular here at DU because, let's be honest, this place is clearly to the left of moderate Democrats, but then they're the ones who regularly get smeared as being "DINOs" or "Republican Lite".
But it's best not to be so conceited that when you look in the mirror you believe you see America reflected back and only you know what's best for everyone.

[Auggie]

76. K&R

[Amimnoch]

77. For full honesty, it's not a POTUS issue for the most part.

Regardless if it's enhanced ACA with/without single payer, MFA, or some other version, WE have to elect the congress that will pass it.

No major change is going to happen by executive order.

I strongly suspect that, unless we get a congress in place like FDR had (no path to this in the 2020 Senate), any bill that does manage to pass that progresses our healthcare system is going to be flawed in some way and not make everyone happy. The only thing I care about in our candidates with regards to this is that if we do get a congress that passes something that moves us forward.. to any degree.. in any way.. that is championed by our Democratic Party members in congress, that the POTUS will sign off on it and not Veto it. With the sole exception of Bernie Sanders, I trust that any of our great field of candidates would sign off and not pull out the veto pen.

[Crafty Girl]

82. Oh, where to begin with this???

"Hail Mary" procedures during the last months of life are cruel and they bankrupt survivors.

Seriously, do you really believe that patients with cancer ought to be denied "Hail Mary" treatments, on the basis of cost?

Our society CAN NOT afford all of the therapies that have been invented.

Some of those therapies SAVE LIVES.

Cancer wards are shiny new trimmed in brass and mahogany. The mental health unit is in the basement of a 100 year-old building. Which unit do you suspect is funded by private insurance? Which one largely serves Medicaid patients?

Many of those "shiny new" facilities are funded by private donors and foundations, not private insurance.

These will be major disruptions to our current medical model. They will not be without some pain and sacrifice to providers and currently-entitled consumers.

You can accept "pain and sacrifice;" I won't.

[The Mouth]

83. Any finite quantity *will* be rationed (apportioned) in some manner

FACT: there is more demand than supply

THEREFORE: some mechanism will be used, has to be used, to apportion who gets what. and absolute truth in any situation of greater demand than supply.

There really are only a few options:

1- Government experts ('bureaucrats') prioritize patients and procedures

2- Insurance companies, via their adjusters prioritize patients and procedures

3- the 'free market' via direct ability to pay does so.

Or our current unholy combination of the above.

There is, and must be, and always will be "rationing" of healthcare as long as more people need it, at any given moment, than there are providers and facilities to see them the moment they need it. The discussion needs to be about who and how.


If there are two people that need a lifesaving heart operation, and one surgeon, team, and operating room, how is the choice made? who makes it?

- Someone is Washington D.C or other government office
- Someone at Blue Cross or Kaiser
- Whoever can afford it and afford to have it first.

As the OP points out, without acknowledgement of this fact, any opinion or discussion is just grandstanding and B.S.

[Mosby]

85. Howard dean said universal health care could be paid using tariffs

But that was back when liberals cared about fair trade.

[MBS]

86. Bloomberg op-ed on Buttigieg health plan

https://www.bloomberg.com/opinion/articles/2019-09-19/buttigieg-s-health-plan-gets-one-big-thing-right
excerpt:


.

. . One crucial difference — and not just with Biden’s plan — is that Buttigieg’s proposal explicitly calls out hospital and provider prices as a critical driver of health care costs. His plan would cap out-of-network provider charges at double what Medicare would pay for the same service. Many providers charge substantially more than that, but even Democratic presidential candidates tend to avoid the issue and focus on easier political targets like insurers and drugmakers. Out-of-control prices are an inevitable consequence of America’s confusing mash-up of private employer coverage, public plans and individual insurance options. Fragmentation reduces negotiating power and makes it extremely difficult to bargain effectively with providers, especially as hospitals consolidate.
. . .
Even candidates like Senators Elizabeth Warren and Bernie Sanders who call for “Medicare for All,” which would require steeper and more widespread provider cost cuts, don’t go out of their way to talk about the issue. Provider prices came up only a few times across five Democratic debates in which health care received sustained airtime. It’s a touchy subject, considering the large number of people employed by health providers and their relative popularity among voters.

Buttigieg’s willingness to openly address the issue is a refreshing step forward in the health policy debate and boosts the appeal of his plan. His proposal would retain many of the current system’s flaws, even with the addition of a public option. But the cap has the chance to improve matters substantially. On top of cutting outlier prices, it would bolster negotiating leverage for the public option and private plans by making it less lucrative for providers to refuse to join insurance networks. It could bring the cost of insurance and care down and expand access in a less disruptive manner.

In many ways, his plan still falls far short of single-payer options. Medicare for All could do far more to bring costs down by folding people with private insurance into a national plan and would provide substantially more generous coverage to many more people The cost of such a plan and voter concerns about eliminating private coverage means it’s not guaranteed to pass even if Democrats take back the White House and Senate. In that light, it’s refreshing to have a more moderate alternative that at least acknowledges and attempts to tackle one of the health system’s biggest issues.

[Gothmog]

87. NBC/WSJ poll shows Biden's healthcare stance (optional Medicare buy-in) much more popular

Link to tweet

Link to tweet